运动试验中R波及T波振幅变化对诊断冠心病的意义

Amplitude changes of R wave and T wave in exercise test and their values in diagnosis of coronary heart disease

目的探讨平板运动试验（TET）过程中引起R波电压降低或T波增高的特征、临床意义及其与冠状动脉病变的关系。方法通过对672例行TET检查患者的心电图进行分析，筛选出R波电压降低或T波增高患者，对其心电图特征进行分析并与冠状动脉造影检查进行对比观察。结果22例患者在试验中出现R波电压降低，其中17例开始于运动中2～8min，5例发生于运动结束后2～6min；R波电压降低持续4～6min；出现在V4～V6导联16例，Ⅱ、Ⅲ、aVF导联6例。11例在试验中出现T波增高，其中9例开始于运动中2～8min，2例发生于运动结束后2—4min；T波增高持续2～6min；出现在V2～V4导联9例，Ⅱ、Ⅲ、aVF导联2例。33例患者冠状动脉造影显示均有管腔狭窄病变，其中左冠状动脉前降支病变20例，左冠状动脉回旋支病变4例，右冠状动脉病变4例，左冠状动脉前降支＋右冠状动脉病变5例。结论TET检查诱发R波电压降低或T波增高是判断冠状动脉狭窄病变较为可靠的指标。

Objective To investigate the characteristics and clinical significance of the decrease of R wave or increase of T wave in electrocardiograms （ECG） during treadmill exercise test （TET）, and the relationship between these changes and coronary heart disease （CHD）. Methods The patients （n = 672） with the decrease of R wave or increase of T wave after routine TET were chosen through the analysis on their ECG. The characteristics of ECG of these patients were analyzed and compared with their results of coronary arteriography. Results The decrease of R wave was observed in 22 cases,which began at 2 - 8 minutes during TET in 17 cases,and at 2 -6 minutes after TET in 5 cases. The decrease of R wave lasted for 4 -6 minutes,and emerged in leads V4-V6 in 16 cases and in Ⅱ , Ⅲ and aVF in 16 cases. The increase of T wave was observed in 11 cases, which emerged at 2 - 8 minutes in 9 cases during TET and at 2 - 4 minutes after TET in 2 cases. The increase of T wave lasted for 2 - 6 minutes and emerged in leads V2-V4 in 9 cases and in Ⅱ , Ⅲ and aVF in 2 eases. The results of coronary arteriography showed that there was arterial stenosis in 33 cases,among them stenosis of left anterior descending branch （LAD） in 20 cases,left circumflex branch （LCX） in 4, right coronary arteries （RCA） in 4 and LAD ＋ RCA in 5. Conclusion The decrease of R wave or increase of T wave induced by TET may be the reliable indicators in the diagnosis of the stenosis of coronary arteries.